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Medical Billing Clearinghouse: What is the Role of a Medical Clearinghouse?

In the world of medical billing, there are a few concepts that can get a bit confusing. One of these concepts is that of a medical clearinghouse. What exactly does a clearinghouse do, and why is it important?  Let’s discuss the role of the medical clearinghouse, its benefits, and how to choose one.

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What They Do

A medical claims clearinghouse acts as a middleman between the provider (doctor, dentist, chiropractor, etc.) and the payer (insurance company). The practice management software on a billing professional’s computer creates an electronic file (the claim) also known as the ANSI-X12 837 file. This file is then uploaded to your medical billing clearinghouse account.

From here, the clearinghouse then checks the claim for errors, ensuring that the claim can be properly submitted to the payer. Once the claim passes inspection, the clearinghouse securely transmits the electronic claim to the payer with which it has already established a secure connection that meets the strict standards laid down by a HIPAA.  The claim is then either approved or denied by the payer, in which an approved claim generates a payment of services to the provider, and a denied claim may require additional information to procure processing.

Benefits of Clearinghouses

The main benefit of the clearinghouse is efficiency. Clearinghouses scrub medical claims to ensure correct data entry for properly processed claims. Without this error checking, incorrect claims would be submitted to payers on a more regular basis. Incorrect claims cause inefficiency in the workplace, more work for your staff and the payer, and often result in denied claims due to incorrect filing or coding.

Another benefit of using a clearinghouse is the integration between the payer’s software and the provider’s software. Each payer and provider are likely to use different softwares, but these softwares are not necessarily compatible with each other. When using a clearinghouse that integrates with each software separately, the payer and provider are able to allow each software system to communicate through electronic data integration (EDI).

How To Choose One

When choosing a clearinghouse, it is important to keep the following aspects in mind:

  • User-friendly Interface
  • Integration with Existing Practice Management Software
  • Customer Service & Support
  • Privacy Practices & Compliance

With a friendly user interface that integrates with dozens of existing practice management softwares, Apex EDI is the premier choice for medical claims processing. Our clearinghouse is dedicated to upholding exceptional practices with regards to customer service, as well as compliance with federal privacy practices such as HIPPA.

For more information, be sure to reach out to us on our Contact Us page.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Medical Billing Clearinghouse

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  1. Rahul January 10, 2017

    What if i want to send secondary claim through clearing house with the payment or adjustment of primary insurance. Is it possible if both payer’s are commercial and not federal

    reply

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